Vascular surgery is concerned with the investigation and treatment of arterial diseases affecting the aorta and its branches and the arteries in the limbs and the neck, but excluding the coronary arteries. It is also concerned with the management of diseases of the venous system.

DISORDERS OF THE ARTERIAL SYSTEM

Arterial surgery has evolved rapidly over the last 50 years with the development of bypass techniques, prosthetic materials, sutures, percutaneous procedures and imaging. The number of patients treated annually continues to increase in parallel with the increasing age of the population.

A comprehensive review of the basic sciences in relation to the specialty of vascular surgery is beyond the scope of this book; however, some significant features are covered below.

Anatomy

The heart pumps blood in to the aorta, a large diameter vessel. With repeated branching the total cross-sectional area of the vessels increases in size until that of the capillaries is approximately 1000 times that of the aorta.

Collateral circulation

The development of collateral circulation is an important concept in arterial disease. In acute ischaemia the rapidity of onset prevents adequate collateral development; however, with slowly progressive chronic ischaemia, the collateral development may be so extensive as to fully compensate for major arterial occlusions (Fig. 15.1).